AB0806 Gender and Imaging Progression in early Axial Spondyloarthritis: Results from a 48-month follow-up (Italian arm of SPACE study).
Authors: M. Lorenzin, A. Ortolan, S. Vio, G. Cozzi, V. Scapin, G. De Conti, A. Doria, R. Ramonda
Journal: Annals of the Rheumatic Diseases (2022)

Background Gender differences in disease presentation and imaging features of early axial-spondyloarthritis (axSpA) have not been thoroughly investigated. Objectives To assess the influence of gender on spinal/pelvic radiographic progression and magnetic-resonance-imaging (MRI) features in early-stage axSpA. Methods Baseline data from the Italian arm of SPondyloArthritis-Caught-Early-cohort, including patients with chronic-back-pain (CBP;duration≥3 months and ≤2 years;onset&lt;45 years) were analyzed.Patients underwent a diagnostic work-up, including MRI and X-rays of the sacroiliac joints (SIJ), to establish a diagnosis of axSpA (according ASAS criteria). Clinical features, disease-activity and functional indices, imaging were collected at baseline (T0) and yearly during 48-months.Spinal and SIJ X-rays and MRIs were performed every 2-years and scored independently by 2 readers following Stoke Ankylosing Spondylitis Spinal Score System modified by Creemers (mSASSS) (score 0-72), modified New York criteria grading system (mNY-criteria) (score 0-4 per each joint) and Spondyloarthritis Research Consortium of Canada (SPARCC) (score of 0–40 for SIJ and of 0-92 for the spine). Characteristics of axSpA patients according the gender (male/female) were compared over-time with descriptive-statistics; multivariate-logistic-regression model was constructed to assess predictors of spinal and SIJ radiographic progression at 48-months. Results Out of 98 CBP patients, 91 had axSpA (83.5% non-radiographic;16.5% radiographic);47.3% were male. At T0 males were younger with less axial symptoms duration (p=0.04);had more frequently human-leukocyte-antigen (HLA)-B27+ (p=0.02),radiographic sacroiliitis with bilateral/symmetric pattern (p&lt;0.02) and more signs of spondylitis (p=0.03).Females presented more frequently an associated peripheral/entheseal involvement (p=0.04) and a non-radiographic form (p=0.03). Functional and disease-activity indices decreased with slightly higher Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), Visual Analogue Scale of pain (VAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) values in females (p&lt;0.04). Males showed a slight increased for both pelvic and spinal radiographic progression than females (Figure 1 A-E ).At T0, 62 (68.1%) axSpA patients presented inflammatory lesions on MRI-SIJ, with more signs of active sacroiliitis in males (83.7% vs. 54.2%;p&lt;0.05).Fifty-seven (62.6%) patients showed inflammatory-corner-lesions on MRI-spine: the frequency of these lesions no differed between males and females, while the localization varied:prevalently cervical/thoracic lesions were observed in females, instead lumbar lesions in males (p&lt;0.05).We also found a higher prevalence of signs of active anterior spondylitis without active sacroiliitis on MRI in females (29.2% vs. 14.0%;p=0.03).Signs of enthesitis were found in 68.1% patients, with slightly higher prevalence of these lesions in thoracic area in females (p=0.04).Significant downtrend of SPARCC SIJ/spine scores was found, regardless the gender.More fat lesions were observed on MRI-spine in females, while more fat lesions were observed on MRI-SIJ in males (Figure 1 F-G ).Skin psoriasis was a predictor of spinal progression in all patients (OR=0.18; 95%CI:0.04-0.78). Conclusion The gender was associated with distinct axSpA features.Males had an increased pelvic and spinal radiographic progression and more frequently active sacroiliitis on MRI.Female axSpA showed a higher prevalence of cervical and thoracic spine-MRI signs (inflammatory-corner-lesions and fat lesions). Disclosure of Interests Mariagrazia Lorenzin: None declared, Augusta Ortolan: None declared, Stefania Vio: None declared, Giacomo Cozzi: None declared, Vanna Scapin: None declared, Giorgio De Conti: None declared, Andrea Doria Grant/research support from: AD has received honoraria and speaker fees from Novartis, Abbvie, Pfizer, MSD, Janssen., Roberta Ramonda Grant/research support from: RR has received honoraria and speaker fees from Novartis, Abbvie, Pfizer, MSD, Janssen.